Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid in New York City, NY

Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - New York City, NY - work from home job

Company: RCM Health Care Services

Job description: Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid (Combination Field, Office and Remote)

Salary is $103,000 to $113,000 with Generous Benefits (Pensions Plan)

For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life. They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.

Position Overview

The primary function of the Senior Clinical Quality Reviewer is to assess and audit medical charts for compliance with a focus on HEDIS, QARR, Medicare Advantage Star measures, CRG and quality improvement activities. This position will assist in the development and participate in the implementation of initiatives across a broad array of clinical measures and health improvement activities. Quality audit findings from this position will contribute to the support and training of physicians on proper coding and medical record documentation practices to support improvement in quality metrics. As a result, this role will be required to conduct regular internal provider audits and then document, summarize, and report findings. Additionally, participation in the annual HEDIS and QARR hybrid medical record review project will be required. This role may also participate in member outreach and education as needed to ensure members receive appropriate services. In addition, this position will provide support and training to physicians on proper coding and medical record documentation practices to support improvement in quality metrics.

The position will be designated as telecommuting and will require conducting field work including in-person provider meetings, on-site chart review or collection, and/or coming to the main office, as needed.

Job Description Minimum Qualifications
? Bachelor's Degree required; and 5-7 years of experience with medical record review/audit working on HEDIS/QARR in a health plan setting; or
? An equivalent combination of training, educational background and experience in related fields and educational disciplines.
? Prior experience in Quality Improvement in a health care and/or Managed Care setting strongly preferred.
? Knowledge of HEDIS and NYS QARR specifications required.
? Knowledge of ICD-10 and CPT codes required.
? Intermediate knowledge of Microsoft Office applications including Word, Excel, PowerPoint, Access, and Visio.
? Experience with relationship management.
? Ability to travel within the service area.
? Active NYS clinical license required.

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Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - New York City, NY - work from home job

Expected salary: $103000 - 113000 per year

Location: New York City, NY
Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - New York City, NY - work from home job

Job date: Sun, 27 Aug 2023 05:01:11 GMT

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Senior Clinical Quality Reviewer (LPN, RN, LMSW) / NYC / Hybrid - RCM Health Care Services - New York City, NY - work from home job

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